Case report: treatment of open femoral shaft fracture in a severely burned patient.

Chang TL, Spence RJ, Mears SC - Eplasty (2008)

Bottom Line:
The patient was treated with intubation, intravenous antibiotics, and debridement and intramedullary nailing for the femur fracture.The patient was returned to full weightbearing and good function with a fully healed femur.Treatment of open fractures in burn patients should be tailored to the specific needs of the individual; they should be reduced and stabilized via internal fixation at the earliest opportunity and should be managed by minimizing wound colonization through successive debridement, wound care, and consideration of flap coverage.

Objective: To present a case report of a patient with an open fracture and severe burns and review the literature.

Methods: The patient was treated with intubation, intravenous antibiotics, and debridement and intramedullary nailing for the femur fracture. He later underwent multiple burn excision procedures with allograft and autograft skin coverage. The wound over the fracture was treated with dressing changes. The fracture was treated with nail exchange and bone grafting for atrophic nonunion.

Results: The patient was returned to full weightbearing and good function with a fully healed femur.

Conclusions: Treatment of open fractures in burn patients should be tailored to the specific needs of the individual; they should be reduced and stabilized via internal fixation at the earliest opportunity and should be managed by minimizing wound colonization through successive debridement, wound care, and consideration of flap coverage.

Figure 4: Intraoperative photograph of cancellous bone chips packed into the femur through a chest tube.

Mentions:
Approximately 1 year later, the patient returned to the orthopedic clinic with a painful atrophic nonunion of his fracture (Fig 3). The nail appeared to be loosening, so dynamization was not considered to be an option. His thigh wounds had healed completely. The nonunion was treated with reaming, allograft cancellous chips (impacted through the medullary canal via a chest tube before nailing), and nail exchange (a larger femoral nail) (Fig 4). In 3 months, the patient was able to ambulate and bear weight on his right leg without pain. Two and a half years after the index procedure, the patient's painful distal locking femoral screws were removed. The patient proceeded to return to full weightbearing and is functioning well with a fully healed femur (Fig 5). Full soft tissue coverage and healing of the thigh wound were achieved (Fig 6).

Figure 4: Intraoperative photograph of cancellous bone chips packed into the femur through a chest tube.

Mentions:
Approximately 1 year later, the patient returned to the orthopedic clinic with a painful atrophic nonunion of his fracture (Fig 3). The nail appeared to be loosening, so dynamization was not considered to be an option. His thigh wounds had healed completely. The nonunion was treated with reaming, allograft cancellous chips (impacted through the medullary canal via a chest tube before nailing), and nail exchange (a larger femoral nail) (Fig 4). In 3 months, the patient was able to ambulate and bear weight on his right leg without pain. Two and a half years after the index procedure, the patient's painful distal locking femoral screws were removed. The patient proceeded to return to full weightbearing and is functioning well with a fully healed femur (Fig 5). Full soft tissue coverage and healing of the thigh wound were achieved (Fig 6).

Bottom Line:
The patient was treated with intubation, intravenous antibiotics, and debridement and intramedullary nailing for the femur fracture.The patient was returned to full weightbearing and good function with a fully healed femur.Treatment of open fractures in burn patients should be tailored to the specific needs of the individual; they should be reduced and stabilized via internal fixation at the earliest opportunity and should be managed by minimizing wound colonization through successive debridement, wound care, and consideration of flap coverage.

Objective: To present a case report of a patient with an open fracture and severe burns and review the literature.

Methods: The patient was treated with intubation, intravenous antibiotics, and debridement and intramedullary nailing for the femur fracture. He later underwent multiple burn excision procedures with allograft and autograft skin coverage. The wound over the fracture was treated with dressing changes. The fracture was treated with nail exchange and bone grafting for atrophic nonunion.

Results: The patient was returned to full weightbearing and good function with a fully healed femur.

Conclusions: Treatment of open fractures in burn patients should be tailored to the specific needs of the individual; they should be reduced and stabilized via internal fixation at the earliest opportunity and should be managed by minimizing wound colonization through successive debridement, wound care, and consideration of flap coverage.